Chronic diabetic foot ulcers, venous leg ulcers and pressure ulcers affect a large subset of the United State population yet they remain a challenge for physicians to treat. There are many different types of products on the market for the treatment of chronic wounds. Some use living cells but only two are FDA approved to heal chronic wounds. A new type of product recently garnered attention in the wound care market because it also contains living cells: hypothermically stored amniotic tissue products. Hypothermically stored amniotic tissue is unique because it maintains living cells and offers the benefits of containing signaling molecules and maintaining an intact extra cellular matrix. While there are other types of amniotic or placental tissue products in the wound care market, they are processed by dehydration or cryopreservation which limits their capacities for maintaining living cells. This thesis will explore the potential for hypothermically processed amniotic tissue products to treat chronic wounds.

Background: Chronic wounds are a significant health problem in various populations. Psychosocial stress is a lifestyle factor that has been shown to directly influence wound healing. Current findings support roles for assessment and reduction of psychosocial stress in the comprehensive management of chronic wounds, however, a gap remains between current research and current clinical practice. Purpose: To develop a novel method by which to educate nurses about the effects of psychosocial stress on wound healing while incorporating state-of-the-art technology that is sensitive to the needs of individuals with various learning styles. Objectives: To review current literature documenting the relationship between chronic psychosocial distress and delayed wound healing to identify essential content to include in educational modules for nurses. To develop three educational modules for nurses in inpatient and outpatient settings that address the relationship between chronic psychosocial distress and delayed wound healing, and the effects of stress-reduction interventions in formats that meet the needs of different learning styles. To conduct a focus group discussion with nurse-participants regarding educational module content and delivery methods in order to evaluate and improve these educational modules. Methods: A series of literature reviews were performed between June, 2010 and October, 2013, using articles identified through searches using the databases PubMed and CINAHL. Essential content regarding psychosocial stress and its impact on wound healing was identified, and was used in the development of educational modules, designed to meet the basic needs of individuals with different learning styles. A purposive sample of nurses was recruited through the use of flyers, reviewed the educational modules online, and met for a focus group to discuss their experiences with these modules. Outcomes: A novel method was developed by which to deliver educational material to nurses about psychosocial stress and delayed wound healing. Participants were motivated to learn, had self-awareness of their preferred learning styles, and responded positively to this method of education delivery; they were able to articulate the basic concepts presented in the modules. These findings may be generalizable to a larger audience and may inform the development of future education-delivery approaches in this area.

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Chronic wound healing can be seriously impeded by the formation of biofilms, infections, peri-wound edema, hematoma, osteomyelitis, and the formation of reactive oxidative species (ROS). We hypothesize that a scaffold created from Silver-Doped Nanoceria (AgCNP) embedding silk can be beneficial to aid the wound healing process, inhibit inflammation and prevent microorganisms from forming a biofilm over the wound. Current wound healing methods such as intradermal injections are not advantageous to use since they can cause unwanted responses elsewhere in the body other than the wound site. Silk, however, has a positive impact on the wound healing effect and can be used as an alternative delivery method to deliver the drugs to the target site rather than intradermal injections since its degradability is controllable and it is bioresorbable, therefore it can get absorbed by the body and degrade safely without causing bodily harm. AgCNPs are used as they have antimicrobial/antioxidant properties to scavenge harmful ROS species at the wound site and can also modify silk for UV protection. As silk's degradability can be controlled, our experiment will involve collecting data on release studies conducted in vitro to see how long it takes for the silk patch to release the drugs. Our goal is to ensure the drug is not released immediately but rather over a longer controlled time manner to protect the wound while healing.

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No / Larval biotherapy is a debridement tool used in wound management. The mechanism of action involves degradation of eschar by serine proteases including chymotrypsin within the alimentary fluids of first instar Lucilia sericata. With the rationale of obviating some limitations of biotherapy, including cost, complexity of use, and patient reticence, the present study describes a mobile hydrogel formulation containing freeze-dried recombinant L. sericata chymotrypsin designed for topical application. Neither freeze-drying nor formulation into the hydrogel significantly attenuated the measured activity of released enzyme compared to fresh-frozen enzyme in aqueous solution. Gel electrophoresis confirmed qualitatively that the chymotrypsin/hydrogel formulation both with and without supplementary urea at 10% w/v degraded human chronic wound eschar ex vivo. Mindful that the hallmark of intractability of chronic wounds is aberrant biochemistry, the pH activity profile for the enzyme/hydrogel formulation was compared with exudate pH in chronic wounds of mixed aetiology in a cohort of 48 hospital in-patients. Five patients' wounds were acidic, however, the remainder were predominantly alkaline and coincided with the pH optimum for the insect enzyme. Thus, a recombinant L. sericata chymotrypsin and hydrogel formulation could represent a pragmatic alternative to larval therapy for the management of chronic wounds.

Depuis une dizaine d'année, le rôle des biofilms dans la résistance aux antibiotiques et à la réponse immunitaire a été mis en évidence dans les infections chroniques. Les plaies chroniques possèdent ces mêmes particularités de résistance aux divers traitements. La formation de biofilm dans les plaies induit une protection des bactéries qui participe potentiellement à la chronicité et est responsable de l'inefficacité des soins. Le but de ma thèse est de concevoir un biogel actif contre les biofilms pouvant être présents dans les plaies chroniques.Nous avons développé un gel de gélatine innovant contenant divers agents anti-biofilms et permettant l'éradication des bactéries pathogènes. Ces gels sont des solides mous composés d'une phase liquide emprisonnée dans un réseau de biopolymères. Biocompatibles et biorésorbables, ils présentent des avantages pour une utilisation en tant que biomatériaux pour la santé. Il est possible d'y inclure des molécules qui vont ensuite diffuser vers le milieu extérieur. Pour mieux appréhender cette cinétique de diffusion, nous avons étudié le relargage de molécules modèles de différents poids moléculaires et de différentes charges.La stratégie anti-biofilm adoptée consiste à prévenir la colonisation bactérienne, déstabiliser le biofilm et éradiquer les bactéries pathogènes de la plaie (Diminution de la biomasse d'au moins 5 logarithmes). Pour développer ce système, 3 types de molécules ont été combinées : un antiseptique commercial, utilisé dans le cadre des soins des plaies chroniques, un chélateur d'ions actifs contre les MMPs surexprimées dans les plaies et une protéase capable de dégrader la matrice du biofilm. Cette étude a été réalisée sur des biofilms mono-espèce de P. aeruginosa et S. aureus, bactéries pathogènes fréquemment retrouvées dans les plaies chroniques. La combinaison des principes actifs a été testée en solution, en contact direct avec le biofilm. Puis, les agents ont été encapsulés dans un biogel. Nous avons étudié à la fois les propriétés viscoélastiques de ces gels mais aussi leur efficacité contre un biofilm, comparé au traitement non encapsulé. Lors de ce travail, nous avons élaboré un gel manipulable capable d'éradiquer un biofilm mono espèce ou multi espèces, constitué de souches de laboratoire ou de souches cliniques issues de plaie chronique. / Over the past 10 years, researchers have highlighted the role of biofilms on resistance to immune response and antibiotics treatments of chronic infections.Chronic wounds share these characteristics as they are resistant to care treatments. The possible biofilm formation in wound can protect bacteria participating to the chronicity and the resistance to wound care treatment. The aim of this thesis is to conceive a biogel against biofilms in chronic wounds.We have developed an innovative gelatin gel containing various anti-biofilm agents able to eradicate pathogenic bacteria biofilm. This gel is soft matter composed of a liquid phase entrapped in a biopolymer network. It is biocompatible and bioresorbable; these properties are necessary for a biomaterial. The gel has the capacity to deliver molecules with controlled release. We have studied the release of model molecules with different charges and weights.The anti-biofilm strategy consisted in preventing bacterial colonization, disrupting the biofilm and eradicating pathogen bacteria in wound (a decrease biomass of at least 5 log reductions). The system developed consisted in the combination of three different types of molecules: a commercial antiseptic usually applied in chronic wound care, an ion chelator active against MMPs which are over-expressed in chronic wounds and a protease which can disrupt the matrix of the biofilm.The study has been carried out on mono-species biofilms synthesized in vitro, with P. aeruginosa and S. aureus, two pathogenic bacteria frequently encountered in chronic wounds. The combination of the active agents was tested in solution or in directly contact with the biofilm. Then molecules were entrapped in the biogel. The viscoelastic properties of the gel were studied and the efficacy of the entrapped treatment compared to that of the solution. A handeable and efficient biomaterial has been elaborated during this study. It is able to eradicate mono – and multi- species biofilms from both laboratory and clinical bacterial strains.

Abstract Chronic, non-healing wounds constitute a massive financial burden on health care system. The healing processes of these wounds and their underlying pathology are only partly understood. In this study, important biological functions performed by Retinoic acid with its regulatory protein cellular retinoic acid binding protein 2 (CRABP2) were discussed. Possibly, these biological func-tions might be linked with chronic wound therapeutic by inducing antiproliferative activity of cells which leads to reduction in migration and growth rate of fibroblast during skin regeneration pro-cess in chronic wound healing. The aim of this study was to comparatively analyze the expression pattern of CRABP2 and P16 cyclic dependent kinase inhibitor in dermal fibroblasts at mRNA levels along with their morphological pattern, migration and growth rate. Fibroblasts were cultured and their morphology were observed by phase-contrast imaging. Difference in viability, migratory capacity was examined by Cell titer blue and scratch assay respectively and expression were meas-ured by polymerase chain reaction. Interestingly, the date revealed that morphology was altered and growth rate and migration velocity was significantly lower in chronic wound fibroblasts and senescent fibroblasts when compared with their control. Expression pattern revealed that CRABP2 was highly up-regulated only by senescent cells but not in chronic wound fibroblasts which point novel function for this protein in term of replicative senescence. However, P16 was not signifi-cantly altered among all fibroblasts which demands supplementary studies to conform the role of CRABP2 in fibroblast dysfunction and cellular senescence in chronic wounds.

Chronic wounds are a major financial and clinical burden causing the deaths of millions per year. Over expression of elastase is well documented as the main culprit that delays the normal wound repair process within chronic wounds. The aim of this thesis is to design a responsive chronic wound dressing based on the hydrogel polymer, PEGA (polyethylene glycol acrylamide) in the form of particles to mop-up excess elastase by exploiting polymer collapse in response to elastase hydrolytic activity within sample fluids mimicking the environment of chronic wounds. PEGA particles were functionalised with enzyme cleavable peptides (ECPs) containing charged residues. Upon cleavage the charge balance changes, causing polymer swelling and consequent elastase entrapment. The pH range of chronic wounds is reported in the range of 5.45 - 8.65. Due to its pI which is around 8.3, within this range elastase exist both in its cationic and anionic forms. To accommodate a hydrogel dressing that could selectively entrap excess elastase both in its cationic and anionic, oppositely charged ECPs were designed. In its cationic form, elastase was found to have a high preference of cleaving ECPs and penetrating into PEGA particles bearing negative charges. In contrast, in its anionic form the opposite effect was observed, wherein elastase preferred to cleave ECPs and penetrate PEGA particles bearing positive charges. The diffusion, accessibility and entrapment of elastase into functionalised PEGA particles was explored using various fluorescence microscopy techniques. Removal of the charged residue by elastase showed a reduction in particle swelling causing the pores of PEGA particles to become restricted. In this manner, cleaved PEGA particles prevented the accessibility of molecules with a molecular weight as low as 20 kDa into the cleaved PEGA particles. Since elastase has a molecular weight of 25.9 kDa the collapsing of the pores within PEGA particles entrapped elastase inside the interior of cleaved PEGA particles. In its cationic form (at pH 7.4) elastase was found to penetrate and become trapped more into both negative and positive PEGA particles compared to neutral particles. The negative particles were shown to trapped cationic elastase within 2 minutes compared to the positive particles. In contrast, the neutral particles failed to retain and encapsulate elastase as the fluorescence inside the neutral particles was found to decrease. Coinciding with these observations, after sample fluids containing elastase were treated with functionalised PEGA particles, the residual elastase activity in sample fluids was reduced more by the charged PEGA particles compared to neutral particles. The cell culture studies demonstrated that the elastase activity observed in human dermal fibroblasts (HDF) was also reduced more by the charged particles compared to the neutral particles. However, the positive particles were found to significantly reduced HDF-elastase activity compared to both the negative and neutral PEGA particles. Overall, this thesis exemplifies that on the basis of charge selective cleaving of ECPs coupled to PEGA particles can be exploited to selectively remove excess proteases such as elastase from sample fluids mimicking the environment of chronic wounds.